Public Bill Committee

[Derek Conway in the Chair]

Further written evidence to be reported to the House

H&SC 26 Equality and Human Rights Commission
H&SC 27 Unison
H&SC 29 Parliamentary Ombudsman and Health Service Ombudsman

Stephen O'Brien: On a point of order, Mr. Conway. I thank the Minister for his two letters that we have received this morning, one on the cost of the new commission and one on complaints handling, which relate to an undertaking given in our proceedings. However, I was a bit disappointed that, while the second letter on complaints identified my question about the backlog of complaints—column 123 of the Official Report—it did not contain the figures. It stated merely that the backlog has now reduced significantly and the Healthcare Commission is now meeting the service level agreement target agreed with the Department of Health to close 95 per cent. of cases within 12 months. I should be grateful to receive the figures in respect of the backlog. Given that we may be debating schedule 5, depending on progress, either today or Tuesday, I should appreciate the Minister providing us with those figures during this morning’s sitting. I ask him, through you, Mr. Conway, whether that might be possible.

Derek Conway: Fortunately, Chairmen of Public Bill Committees are not responsible for the content of ministerial replies. That is a great relief to us all. I am sure that the Minister may want to refer to the matter during this morning’s proceedings, but it is not a point of order for the Chair. I am sure that he will deal with it in due course.

Clause 17

Code of practice relating to health care associated infections

Stephen O'Brien: I beg to move amendment No. 17, in clause 17, page 8, line 41, leave out ‘may’ and insert ‘shall’.

Derek Conway: With this it will be convenient to discuss the following amendments: No. 18, in clause 17, page 9, line 3, at end insert—
‘(2A) The code of practice must make reference to—
(a) screening for admissions,
(b) bed occupancy, and
(c) the frequency and extent of cleaning in healthcare premises.’.
No. 19, in clause 17, page 9, line 7, at end add—
‘(3A) The Secretary of State shall publish each revision of the code.’.
No. 20, in clause 17, page 9, line 7, at end add—
‘(3A) The Secretary of State shall report to Parliament in respect of those cases where—
(a) regulations made under section 16 are breached, and
(b) the Code of Practice under this section is breached.’.
No. 21, in clause 18, page 9, line 13, at end insert—
‘(c) lay the draft code before Parliament.’.

Stephen O'Brien: The amendments build on the themes that were discussed in the debate on clause 16 to ensure effective combating of health care associated infections and clarity in reporting that to Parliament. The Health Act 2006 makes provision for the Secretary of State to issue a code of practice relating to the prevention and control of HCAIs. It was updated most recently on 11 January 2007. As the explanatory notes say, the new code will replace that code and extend it to all regulated activities, not only NHS bodies.
Amendment No. 17 queries why the drafting stands at “may” not “shall”, given the Government’s apparent commitment to the code of practice. That is such an easy one that I am hoping the Minister will get us off to a flying start this morning and accept it, without any cavil. Amendment No. 18 would include in the code action particularly on screening, bed occupancy and the frequency and extent of cleaning in health care premises.
During the oral evidence sessions, Anna Walker from the Healthcare Commission noted that the extra powers given to the commission would not have prevented the outbreaks of infection at Maidstone and Tunbridge Wells NHS Trust, a point that will be important to the discussions on future clauses. However, she noted that the key was to
“get proper infection control processes in place.”
She also said:
“if we find a trust which is cavalier about putting the right processes in, then the penalties will be helpful”,
and that the reality is
“usually more fundamental than that—the team does not understand the processes it needs in place to solve that problem.”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 24.]
Hence, it is crucial that the code of practice gets matters right and that the Committee supports the amendments.
It is reported on page 16 of the current code that it makes provision for screening for methicillin-resistant Staphylococcus aureus. The policy should make provision for admission screening, which should include screening of all elective admissions by March 2009, and for screening of emergency admissions at presentation as soon as it is practical. However, as we know, the Secretary of State has axed the Prime Minister’s promise of screening for clostridium difficile. The Committee may recall that on 6 January on “The Andrew Marr Show” the Prime Minister said:
“If you go into hospital you will get screened by next year for MRSA or C. difficile”.
That was later reported on the BBC under the headline, “Brown pledges superbug screening: All patients entering NHS hospitals in England will be screened for MRSA and clostridium difficile”. No one from the Government sought to correct that story, but two days later on 8 January 2008, in the document “Clean, Safe Care: Reducing Infections and Saving Lives”, the Secretary of State’s infection control strategy reports on clostridium difficile that
“Screening for colonised patients is inappropriate (most potential cases would not be identified, and it requires a stool sample), and colonisation without symptoms is not considered to increase risk of transmission”.
The Secretary of State is obviously admitting that the Prime Minister was wrong. The code makes no provisions for bed occupancy other than saying that on the movement of patients:
“There should be evidence of joint working between the ICT and the bed managers in planning patient admissions, transfers, discharges and movements between departments and other healthcare facilities. Where necessary, ambulance trusts may need to be involved in such planning.”
That sounds like a handbook for shepherding patients. We have all heard anecdotal stories of patients being kept in ambulances to control hospital admissions and targets. In April 2001 in response to the Select Committee on Public Accounts the Government said:
“Health Authorities should plan bed numbers in order to achieve a bed occupancy rate of no more than 82 per cent, in 2003-04.”
After that, the bed occupancy rate went up. It is still at 84.5 per cent. and in many parts of hospitals it is way above that. In the past year, the Government have reduced the number of acute and general beds in the national health service by the largest proportion since 1982. We have seen a reduction of 6,000 acute and general beds, which has taken us down to a figure of 127,000. However, the NHS plan said that there would be an increase of 2,000 beds to take the figure up to 135,000.
Last year, The Independent said that the Department had conducted a review suggesting that reducing bed occupancy to a maximum of 85 per cent. would save 1,000 cases of MRSA a year. Just last week we heard that the Worcestershire royal hospital is running so close to capacity that it has had to cancel operations, send some patients home, send others to the downgraded Kidderminster hospital and enter into punitive negotiations with the independent sector treatment centre there. The hospital in Worcester runs with an occupancy rate that is consistently above 90 per cent.
The third factor that I have outlined should also be considered: the frequency and extent of cleaning in health care premises. As I have discussed on a number of occasions during the Committee’s proceedings, the Prime Minister’s commitment to deep clean appears to be something of a whitewash. Not only have fewer than 50 hospitals actually had the deep clean, but it is being paid for from primary care trust lodgements—the top-slicing that the Government imposed on local health economies to solve their own central financial crisis. The deep clean is important, but it is the maintenance of a clean environment through ongoing cleaning, particularly the search and destroy approach to HCAIs, which we have committed to, that would really bring down MRSA rates.
The current code of practice imposes processes and managerial structures on cleaning, rather than focusing on the nature of cleaning itself and the outcomes required. Given that it is often the refrain of those who make rather obtuse points on the matter, I wish to state that the cleaning services at Maidstone and Tunbridge Wells NHS Trust were not outsourced; they were absolutely in-house.
Amendment No. 21 will formally give Parliament sight of the draft code, which hon. Members from all parties will want the Government to get right. As the points I have outlined show and as we discussed on Tuesday, that is an area where the Government are failing. Parliamentary debate will introduce a more effective strategy and a clear priority focus for parliamentarians and the legislature on one of the key problems in our constituencies at the present time.
Amendment No. 19 is self-explanatory. If the Secretary of State revises the code, it must be published. Amendment No. 20 is similarly self-explanatory and would give hon. Members an early warning of health care associated infection issues in hospitals across the country and in our constituencies.
As the Committee will be aware—it was widely reported on the news last night and this morning—Leslie Ash yesterday settled for £5 million, although there were some reports that it was just £500,000, with the Chelsea and Westminster hospital over her methicillin-sensitive Staphylococcus aureus suffering. Yesterday, The Times reported that legal arguments had begun in the Court of Session in Edinburgh. Judges are to decide whether the case brought by 71-year-old Elizabeth Miller, a great grandmother who contracted the MRSA superbug in hospital, should proceed to a full hearing. She is suing NHS Greater Glasgow and Clyde for £30,000, which could pave the way for hundreds of other sufferers to claim millions of pounds in damages.
Therefore, the key issue is whether, by virtue of these amendments, we would be able to give the necessary priority, focus and parliamentary scrutiny to the revised code of practice, which is required to be published by the Government. The Government themselves proclaim that they are focused on dealing with the matter. We would demand that of any Government given the desperate situations that arise as a result of hospital associated infections.
In looking at this group of amendments, I hope that the Minister will agree that screening, bed occupancy, and the frequency and extent of the cleaning in health care premises, in particular a search and destroy strategy, are key to effective control of health care associated infections. I hope that he will agree with Anna Walker that the problem is more often to do with teams that do not understand the processes that are needed to combat health care associated infections than a cavalier attitude towards putting in the right processes.
Also, why has the Secretary of State reneged on the Prime Minister’s commitment to screen for C. difficile? Why are bed occupancy rates still so high under this Government and why is no mention made of those rates under the current code of practice? Why should right hon. and hon. Members not be formally alerted when the regulations under paragraph 16(5) of the code are breached? How regularly would the Minister expect such breaches and, we would argue, reports to happen? I have high expectations that the Minister will be persuaded by those arguments and accept our amendments.

Sandra Gidley: I understand the motivation behind these well-intentioned amendments. I want to query a few points on amendment No. 18 because it attempts to detail what should go into the Bill. I have some concerns about the list, not because of what is in it but because of what is not. I do not believe that the list is comprehensive. For example, new paragraph (c) refers to the frequency and extent of cleaning in health care premises, but there is no mention of personal hygiene standards or the responsibility of the individual health care workers or even the antibiotic policy which, if we are talking about C. difficile, is just as important, if not more so, as cleanliness. At the moment, I feel that if those aspects are in the Bill, undue emphasis could be placed on the procedures and processes outlined in new paragraph (c), and we might not be able to tackle the overall picture. With the emerging nature of resistant infections, situations may arise which require a change in practice. We need to retain some flexibility so that we can face existing and future challenges.

Stephen O'Brien: I accept the hon. Lady’s fair question. In principle, I think that she is very sympathetic to what we are trying to achieve here. It is clear that a Bill that does not contain anything of this nature would look rather weak because it leaves everything for others to decide. It would be far better not to seek to be comprehensive, because things will move on and change. At this stage it is absolutely clear that the three things cited are fundamental and unlikely to change, and therefore, rather than have a comprehensive list, it is important to identify a focus of activity to allow for prioritisation. At the moment, in terms not only of the Bill but of the way in which the Government are dealing with the matter in general, this issue is not sufficiently high on the agenda, and this an attempt to raise it. I accept that the amendment could have been more comprehensive, but the danger of that is that one then ends up trying to include everything, rather than prioritising.

Sandra Gidley: I thank the hon. Gentleman for his explanation. I am still not entirely convinced. His timing was impeccable, as I was just about to sit down and draw my remarks to a close.

Ben Bradshaw: The hon. Lady is right. As the hon. Gentleman says, it is important that we get these codes right, but as the hon. Lady pointed out, scientific advances and knowledge change continually; we are constantly developing new ways of tackling the challenges, including health care acquired infections. We all hope that some way down the track, if we continue the welcome, significant and sustained fall in health care acquired infections that the Government have achieved in recent years, we will not be worrying so much about this issue, but there may be something else that poses challenges to the health service.
The problem that I have with the amendment tabled by the hon. Gentleman is the same as that expressed by the hon. Lady. The terms of the amendment would place us in a straitjacket, which in the medium and long term could be unhelpful. I expect that it was tabled as a means for having a run-around on some of the Opposition’s old chestnuts about health care acquired infections.

Angela Browning: Will the Minister give way?

Ben Bradshaw: I will give way to the hon. Lady in a second; I just want to put one or two things on the record to correct errors made by the hon. Gentleman. The figure on the deep clean is 80 per cent. of hospitals, and it is already well under way. The £57 million sum for the deep clean is new money for hospitals, out of the £270 million of new money announced in the comprehensive spending review. One example of the unhelpful straitjackets that the amendments would create for the health service concerns bed occupancy rates. As I am sure the hon. Gentleman is aware, the latest research on bed occupancy shows that, although up until 2003-04 there may have been a correlation between high bed occupancy rates and MRSA, since then bed occupancy is “statistically insignificant.” That is a good example of how changes in practices and experience show that putting ourselves in a straitjacket, as the Conservatives are asking us to, could be quite unhelpful. That is true of the guidance and the issues discussed on Tuesday, such as the requirement for the Secretary of State, rather than the independent Healthcare Commission, to report to Parliament about every single little thing that is going on. As the hon. Member for Romsey rightly says, such an approach would mean putting oneself in a rigid system of being required to do things that are no longer important.

Angela Browning: I am somewhat shocked to hear the Minister use the expression “old chestnut” in respect of hospital-acquired infections. I am a member of the Public Accounts Committee. On two separate occasions, his permanent secretary appeared before it and if he had used that expression to it, he would certainly have been put in his place. The permanent secretary will return to the Committee within the next year on this very subject. It is far too serious a subject for the Minister to describe as an “old chestnut.” He has the option of bringing the contents of the amendment back on Report, redrafted by his officials. If he feels that this issue will disappear in a few years’ time—I hope that he is right—something approaching a sunset clause would be appropriate. In other words, let us put it in the Bill because it is important, not an “old chestnut”, and if in five or 10 years it is no longer regarded as necessary, the wording of a sunset clause would mean that it would die a natural death as the need for it disappeared. This issue is serious, and I hope that the Minister will talk to his permanent secretary about his experience before the Public Accounts Committee. I doubt that he thought that it was an “old chestnut”.

Ben Bradshaw: The hon. Lady, inadvertently I am sure, misunderstands my point. I was not saying that the issue of health care acquired infections is an old chestnut—it is an extremely serious issue and that is why it is in the Bill, and why the Government have a £270 million programme to tackle it. It is why I welcome the significant and sustained falls in health care acquired infections that we have achieved in recent years, and I hope that that continues. However, it would be wrong to issue guidelines that are so specific that they are inflexible with regard to the new, independent Care Quality Commission, which we are setting up to help us continue to drive down infection rates.
The “old chestnuts” that I referred to are some of the issues that are regularly raised by the Opposition, based, I believe, on a misunderstanding or an out-of-date understanding of our progress on health care acquired infections. I gave the example of bed occupancy. I am not suggesting for a moment that it is not a serious issue; it is. The Government are tackling it, and we are making welcome progress. There has been a 10 per cent. reduction in MRSA in the last year, a 7 per cent. reduction in C. difficile, and a 32 per cent. reduction in health care acquired infections overall since the base year of 2003-04. I want that progress to continue, but it will not be helped by putting the new independent body into the straitjacket provided by these amendments.

Anne Milton: I welcome the Minister’s reference to the science, and I would be grateful if he gave us the source of the information about bed-occupancy rates. One of the problems with the treatment of health care acquired infections is that precious little science is used. It will be interesting to see what happens next year—when there will not be £270 million, and when PCTs and trusts will have to make their own decisions on where they spend their money—and whether it is felt that the deep clean was worth it and should be prioritised.

Ben Bradshaw: The research that I referred to is a public document published in December—the McCormick report. However, the hon. Lady is absolutely right. I do not want to detain the Committee by going through the entire list of things that have been happening and are happening to help us make this progress, but it is important that we have sustained investment. That is why we welcomed the comprehensive spending review settlement, which is very good as far as our Department is concerned and constitutes a 4 per cent. real increase in spending in the health service for each of the next three years. I am not sure whether the Conservative party is still committed to meeting that spending.
Returning to the substance of the amendments, I do not think that they would be helpful. I understand why they were tabled—to give the Opposition a chance to repeat the inaccuracies that were presented to us on Tuesday—but they would be unhelpful in our efforts to continue the sustained progress.

Stephen O'Brien: I suspect that the rest of the Committee, if they would wipe the smiles of their smug faces, would be equally disturbed and appalled by the Minister’s performance. We could do without smug party points. We are dealing with the deaths of 270 people at Maidstone and Tunbridge Wells that could have been avoided with better procedures. That was a disgraceful performance by the Minister, and I am shocked.

Judy Mallaber: Is the hon. Gentleman seriously suggesting that it is disgraceful to try to promote part of what is being done to deal with this very serious issue? Every member of the Committee agrees that is a very serious issue; is it really disgraceful to point out where we have made, and are committed to continuing, improvements, and to put that on the record?

Stephen O'Brien: We all wish to see the best measures to tackle this. What we do not like is the smug approach taken by a Government who know that they have an inbuilt majority, and who therefore think that the entire procedure of scrutinising the Bill is a waste of time and rather wish that they were not here. Far from it. We are absolutely committed and very sincere about the amendments and we shall be voting on them. This is not a game to get some happy little comments on the record. It is a serious question of trying to get the best performance and prioritisation for dealing with this issue in parliamentary terms. This has become serious because of the tone and attitude of the Minister in responding to a matter of this seriousness. We should recognise, on the record, that that should be repelled.

Richard Burden: May I clarify the hon. Gentleman’s intentions? If I understood his reply to the hon. Member for Romsey, he acknowledged that his amendments may well be defective.

Stephen O'Brien: Not defective.

Richard Burden: Ah—so the hon. Gentleman thinks that the list in amendment No. 18 is complete and comprehensive, and that is why he wishes to press it to a Division. If the amendment is defective, he should withdraw it; if it is not, he should press it to a Division. Which is it?

Stephen O'Brien: I am sure that the hon. Gentleman was listening when I responded to the hon. Lady. I said that the purpose of the amendment was not to be comprehensive, but to highlight and prioritise matters on which Parliament must focus.
Of course, the amendment would give flexibility. We have the Report stage and the Bill will be scrutinised in another place, so the Government could recognise that they can tweak it. If they do not tweak it, and if they choose simply to resist and to make the measures generic and unspecific, that raises questions about the prioritisation of, and focus on, the requirement for accountability to Parliament. There should at least be a tie-in with the Public Accounts Committee, as my hon. Friend the Member for Tiverton and Honiton so ably pointed out, so that there is annual scrutiny, not least in the person of the permanent secretary. We need to tie-in the prioritisation of parliamentary accountability rather than relying, as we will under the Bill, on an Executive who seem not to take the measure with the seriousness that it deserves. They seem to think that the intention behind the amendments is partisan point scoring, which it quite patently is not. I rest my case.

Sandra Gidley: I think that the hon. Gentleman would be best advised to rethink the matter on Report. I am concerned about unintended consequences. For example, if we are too prescriptive about bed occupancy regulations, we could create a conflict. When a person is in an emergency situation, will a hospital official say, “We cannot accept you because we would be in breach of the bed occupancy regulations”? That person could die not because of MRSA, but because they had to be moved to another hospital. Whatever capacity any Government build into the health system, those situations will arise. The hon. Gentleman must think through all the consequences of the amendment. It is well intentioned, but we need to ensure that the situation I described does not arise.

Stephen O'Brien: I am grateful to the hon. Lady, but the amendment states:
“The code of practice must make reference to”.
So the measure would not be exclusive; rather, the intention is to draw attention to prioritisation. Furthermore, if the science says that bed occupancy rates are indeed leading to MRSA, she cannot surely be suggesting that a hospital should accept a person if that would lead to their getting MRSA. On the contrary, the whole point of the science is that it should be a matter of judgment if someone who should otherwise obviously be accepted into a hospital is almost certain to contract MRSA.

Sandra Gidley: Will the hon. Gentleman give way?

Stephen O'Brien: I am not going to give way because the principle at stake in the amendments is clear. They would prioritise what the code of practice refers to. They would not provide an exclusive or comprehensive list, and they would not restrict flexibility, but we do not want the Government to feel that they can simply be trusted to do the right things at the right time, because their track record so far is deeply disappointing.
I am disappointed with the tone and substance of the Minister’s reply, so I shall press the amendment to a Division.

Question put, That the amendment be made:—

The Committee divided: Ayes 5, Noes 10.

Question accordingly negatived.

Clause 17 ordered to stand part of the Bill.

Clause 18

Consultation etc. in relation to code of practice under s. 17

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: I note that in clause 18, both the phrase
“consult such persons as the Secretary of State considers appropriate”
in subsection (1)(b), and the phrase
“substantial change in the code”
are obviously very general statements, as is
“maintaining the power vested in the Secretary of State.”
It would be helpful, as we consider this clause, if the Minister could briefly outline what the force of the statement in subsection (1)(b) is on the consultation. What would he expect a substantial change in the code to be, in terms of degree?

Ben Bradshaw: This leads on rather nicely from the debate that we have just had, because it might have been helpful to say that the codes of practice will be consulted on and debated fully. That will give a chance to hon. Members and anyone who has a view to say what should be in the code. However, this is standard language used in any legislation for consultation. Clearly, the Secretary of State will consult people whom we currently consult. That provides us with the flexibility that we, and the Liberal Democrats, believe is so important in dealing with the ever changing challenges and in taking on board new ways of dealing with those challenges. That is what we intend to do.

Question put and agreed to.

Clause 18 ordered to stand part of the Bill.

Clause 19

Guidance as to compliance with requirements

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: It would be useful for the Committee if the Minister could let us know how regularly the current regulators issue and re-issue such guidance, and how often he expects the CQC to publish such guidance. There is an obvious burden of bureaucracy at issue for providers here, and some indication would be helpful as we consider the clause.

Ben Bradshaw: I cannot answer that question now, but I will try to do so by the end of the morning sitting.

Question put and agreed to.

Clause 19 ordered to stand part of the Bill.

Clause 20

Consultation in relation to guidance under s. 19

Stephen O'Brien: I beg to move amendment No. 76, in clause 20, page 10, line 19, at end insert—
‘(c) consult and have regard to the advice of the service user panel.’.

Derek Conway: With this it will be convenient to take new clause 2—Duty to establish and maintain service user panel—
‘It shall be the duty of the Commission to establish and maintain an advisory panel to be known as “the service user panel”.
(5) The service user panel shall be comprised of such members as appear to the Commission to represent the views and interests of patients, service users and the public.
(6) The service user panel shall have such functions as determined by the Commission.
(7) The functions of the service user panel as determined under subsection (2) must include contributing to and advising the Commission upon:
(a) the annual plans of the Commission for inspections, reviews and special reviews, and inquiries,
(b) guidance on compliance with registration requirements,
(c) indicators to measure the compliance of registered organisations with the registration requirements,
(d) methodologies for performance measurement, and
(e) methodologies for inspection.
(8) The Commission may request the service user panel to help it to ascertain, from time to time, the opinions and level of satisfaction of patients, service users and the public with regard to the activities to which the Commission’s functions relate.
(9) The service user panel may establish and maintain such arrangements for consultation with patients and members of the public as agreed with the Commission as relevant and appropriate to the carrying out of the functions conferred on it by the Commission.’.

Stephen O'Brien: New clause 2 seeks to establish a service user panel, and amendment No. 76 is consequent on that, making sure that the CQC consults such a panel in formulating guidance under clause 19. Naturally, that builds on the discussions that the Committee has already had on service user involvement under clause 2 and amendments Nos. 2 and 134. The Committee can refer back to the points that were made in column 146 and following, rather than me restating them into the record. I hope that that is a helpful reference. I highlight again that, in response to the consultation preceding this Bill, the Department stated that
“many responses supported the greater input from patients and users of services proposed in the consultation document... The Care Quality Commission will be a user focused organisation”—
and I emphasise—
“recognising that it can only do this effectively by involving them.”
Which? notes in its submission:
“It is a startling omission that the new body charged with overseeing the quality of health and social care will not have a duty to take patients’ views into account in the course of their work.”
Again, I would encourage the Minister to heed the Conservative party’s commitment to Healthwatch, a national consumer voice for patients and service users.
The service user panel can provide a high-level mechanism by which the commission can receive advice from service users. Plans, processes and methodologies that are relevant to the quality of care, the experience of service users and the successful engagement of service users generally can be developed in co-operation with an expert group on such matters. Patients and service users will be reassured that there is a voice for their interests at a high level. Moreover, the panel can seek wider views as required, which will further build confidence in the regulator.
Ofcom has a consumer panel that plays a similar role, and it convenes a regular consumer forum of interested parties such as consumer and disability organisations. The Office of the Health Professions Adjudicator, under clauses 101 and 102, and the Council for Healthcare Regulatory Excellence, under clause 108(4), are both given duties to consult the public, including bodies that seem to them to represent the views of patients; there is no such duty for the commission. The service user panel can at least act as a proxy for such wider consultation.
The Minister made clear in an earlier debate that the Department expects the CQC to establish, under schedule 1, paragraph 6, a panel similar to that proposed in the amendment. That will give the commission the duty to establish at least one advisory panel. No doubt, that commitment will be used to call the CQC and the Minister to account when the CQC begins operating.
The Minister noted that he was still reflecting on the issue, and he undertook to come back to the Committee with clearer thinking on the subject. We hope that he will include Local Involvement Networks in the Bill—I am sure that the Committee remembers that discussion—and consultation with patients and service users.
Does the Minister agree that the voice of patients and service users is key to generating effective guidance on compliance with requirements? Does he agree that the new clause and amendment No. 76 would give him the precise vehicle that he seeks, and that he will therefore be minded to accept them?

Ben Bradshaw: As I have indicated in previous sittings, I am still reflecting on the question of public and patient involvement. In respect of the Opposition’s affection for the new national body Healthwatch, there is nothing to stop LINks forming a national network if they wish, but we are trying to move away from the top-down approach from Whitehall to a more bottom-up approach. We would certainly welcome that development. It is very much up to LINks, as autonomous bodies, to decide if that is what they would like to do.
As I have indicated, part 1 requires the commission to have regard for the people who use the services in everything that it does. As the hon. Gentleman acknowledges, the Bill already requires the commission to establish an advisory committee under schedule 1, and it also provides for the commission to establish further committees or sub-committees, such as one that comprises solely service users. They might have specific functions or a more general function, allowing the commission to decide how best to seek input from different representative groups.
The problem with the new clause is that it proposes that the commission should determine the functions of the panel, while specifying a number of functions that must be included. Again, there is a debate to be had between flexibility and inflexibility. The new clause seems to be giving the commission the flexibility to decide how it uses the panel, but we believe that the commission can use a group to look at specific matters. It is important that a representative group should have the freedom to express its views in relation to any of the commission’s functions, rather than being restricted to functions specified in the clause, and any other matters that the commission determines. That is reflected in schedule 1.
Clause 43 requires the commission to publish a document on the frequency of reviews, and clause 75 requires it to publish its programme of special reviews and investigations. As with all the commission’s functions, it must have regard to the views of the public when preparing those documents. On the basis of those reassurances, I invite the hon. Gentleman to withdraw the amendment.

Stephen O'Brien: I am grateful to the Minister for restating that he continues to reflect on these matters. It would therefore be premature to press the amendment at this stage. I think that we can with some confidence look forward to something being produced on Report, given what he said. However, I caution the Minister against being a little too ready to be contemptuous of the concept of Healthwatch. It may well be instructive that he wants to give that rather more thought when he is reflecting on these matters. He will recall that the establishment and coming together of LINks was something that was won in another place on another Bill, on which my noble Friend Earl Howe led. Therefore, the Minister needs to be a bit careful about assuming that he has found the magic recipe for the bottom-up approach, rather than the Whitehall, top-down approach. Healthwatch is intended to be part of an organic, bottom-up approach. Having offered those cautions, but in the positive context in which the Minister is reflecting on these matters, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Stephen O'Brien: I beg to move amendment No. 23, in clause 20, page 10, line 25, at end insert—
‘(c) lay the draft guidance before Parliament.’.
The amendment simply calls for the Secretary of State to lay before Parliament the draft guidance on compliance with requirements. Therefore, this is simply a matter of the Minister letting us know whether he thinks that Parliament should not have the right to debate such guidance.

Ben Bradshaw: As with a similar amendment proposed to clause 18, I appreciate the Opposition’s concern with parliamentary scrutiny of these issues. Again, however, I am not wholly convinced that this proposal would represent the best use of parliamentary time. Standards for better health, against which the Healthcare Commission judges NHS bodies, are not currently laid before Parliament; nor are the national minimum standards that both the Healthcare Commission and the Commission for Social Care Inspection use to determine whether those health and adult social care providers that they register are fit to remain registered.
The clause includes specific provision requiring the new commission to consult on the guidance, or on any substantial revisions to it. The hon. Member for Worthing, West (Peter Bottomley) commented on Second Reading that there is a point at which one has to trust on such matters and the Secretary of State should be relied on to carry out an open and genuine consultation. I argue that we should be equally satisfied that we can rely on the commission to consult such people as are appropriate when developing guidance under the clause. The guidance will then be published. It will be a public document available for anyone with an interest to read. That is a reasonable arrangement. For that reason, I invite the hon. Member for Eddisbury to withdraw the amendment.

Stephen O'Brien: In the light of those comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 20 ordered to stand part of the Bill.

Clause 21

Effect of code under s. 17 and guidance under s. 19

Stephen O'Brien: I beg to move amendment No. 24, in clause 21, page 11, line 17, leave out subsection (3).
I am sure that hon. Members on both sides of the Committee realise that this clause relates to a slightly different concern. Amendment No. 24 would delete subsection (3), which states:
“A failure to observe any provision of a code of practice under section 17 or guidance under section 19 does not of itself make a person liable to any criminal or civil proceedings.”
That removes any legal sanction or teeth behind the provision.
The explanatory notes to the Bill state:
“Although a failure to comply with either the Code of Practice or the Commission’s own guidance does not in itself constitute and offence, they may both be used as evidence in criminal or civil proceedings as examples of what is expected behaviour in the areas they cover.”
Writ large across the amendment are those 270 patients who died from superbugs as a result of the appalling hygiene standards of the Maidstone and Tunbridge Wells NHS Trust, 90 of whom died from C. difficile.
In its report into the deaths at Maidstone and Tunbridge Wells, the Healthcare Commission estimated that
“of the total 345 patients who died in the relevant periods who had been infected with C. difficile, there were approximately 90 deaths where C. difficile was definitely or probably the main cause of death...C. difficile definitely contributed to the deaths of approximately 145 out of 345 people, and probably or definitely to approximately 270 out of 345 people.”
Both the Health and Safety Executive and Kent police investigated whether they could bring charges against senior managers. I think that I am right in saying—I am more than happy to stand corrected if it is not the case—that neither the HSE nor Kent police have yet drawn any conclusions, or brought the matter to a conclusion. That is relevant because the force of this clause may be to limit what the commission can and cannot do.
The Committee will also be aware that the chief executive, Rose Gibb, was told that she would get a pay-off of at least £250,000 when she quit. Although the Secretary of State stepped in to block that payment, the Department has not yet confirmed whether he was successful. The Sunday Express,on 30 December 2007, reported the following:
“Sources at the Department of Health conceded it is ‘likely’ that she will eventually receive at least some of the money when legal arguments are finished.”
Two health care assistants have been sacked from the trust. One staff nurse and another health care assistant have been disciplined, but will remain. In light of that and similar cases, should not the Committee leave the door open for failure to observe the provisions of the code of practice on health care associated infections to be justiciable or triable in court? Does it not say something about the lack of seriousness with which the Government are approaching the issue, and their lack of faith in their own code and in our NHS, that they may be unwilling to do so?
If amended, this clause would enable an individual to sue for negligence on the basis of illness or injuries arising from the failure to observe the code of practice on HCAIs. This issue is crucial to understanding the import of the question whether the clause should stand as it is, thereby removing the teeth of any form of civil or criminal legal sanctions. For example, has the Secretary of State been successful in blocking Rose Gibb’s £250,000 pay-off? I am sure that each and every one of us would regard it as a scandal if she received a penny piece, in the light of what took place. Where are the police investigations up to, and why should such failings not end up in court? If they are not to end up in court, why should we engage the police’s time at all? Surely, the whole point would be to have internal inquiries or a commission inquiry.
If the commission has no teeth, what will be the sanctions? As we all know, it is very rare that one needs to refer to legal sanctions, if they exist, because everyone knows whom they are dealing with—the commission or the police—and where the case may end up. That, in itself, has an extraordinarily powerful effect, without ending up in either civil or criminal proceedings. If those sanctions are not available, I can well imagine that people will be able to run rings round this provision. I hope, therefore, that the Minister realises that our amendment would give to the commission, which the Government are putting into statute, the teeth that it currently lacks, in order to ensure that it is effective. Rejecting the amendment will create problems over time. It would be genuinely instructive to keep in mind the events at Maidstone and Tunbridge Wells and, in particular, Rose Gibb and what might have happened as a result of the failures that she unfortunately allowed to happen.

Ben Bradshaw: This clause and the amendments do not relate to employment contracts or redundancy arrangements, so I shall not comment on them.
I welcome the hon. Gentleman’s support for the new enforcement powers and I share his desire for them to have teeth. However, the amendment is perhaps based on a misunderstanding of, or a blurring of the distinction between, guidance and regulation. The amendment would give statutory force to the guidance, but it is the regulations that will have statutory force. The guidance will inform the regulations, which we will consult on, as I have indicated on a number of occasions. The problem with giving statutory force to guidance is that it is not scrutinised by this House, which is why subsection (2) of the clause clarifies that, as is common, guidance can be used in court as evidence of what could reasonably be expected to constitute compliance with the legislative requirements. Those are what have the legal force, because they are scrutinised by Parliament. That is in the interests of fairness and justice to the accused.
I have made it clear that I do not think the amendment appropriate. The Bill and regulations made under it will set out all the legal requirements that the services must meet. Clause 31 makes it an offence to contravene or fail to comply with those requirements. It would be inappropriate, therefore, to make it a criminal offence not to comply with the guidance, when it will be an offence not to do so with the regulations, which will be informed by the guidance.

Stephen O'Brien: We are genuinely struggling with this point, although I am grateful to the Minister for seeking to address it. Often the easiest way for the Opposition to scrutinise a Bill is simply to ask why something has been drafted in a certain way. However, we really are wrestling with this piece of drafting. Interestingly, during consideration of previous clauses, I did not ask why the Government have used in the Bill the words, “health care associated infections”. The word “associated” seems to have become a substitute for “acquired”, which is more commonly used; indeed, the Minister used it earlier. When one sees a word moved like that, one must question what is meant by it. It could not have happened by accident, because those who draft these Bills are highly expert wordsmiths and lawyers. It is right, therefore, that we question this.
I was very interested in the Minister’s answer. He spoke about how removing clause 21(3) would give guidance statutory force, when it should be, in effect, best-practice advice—I think that that is what he suggested—and about the resulting inflexibility. I can understand that in relation to clause 19; however, clause 17 refers to a code of practice. The Minister, therefore, seems to be saying that the code of practice is no more than guidance. This point has been central to our discussions this morning: are we really saying that, because this is such a framework portmanteau Bill—drafted in generic terms and hugely dependent upon the publication, scrutiny and acceptance of the regulations in order to bring into play the true force of law—the code is to be no more than guidance? In that case, why is there a distinction between “code” in clause 17 and “guidance” in clause 19? If there is no difference, should we not just call them one thing?
Alternatively, should we not recognise that the code is likely to need some statutory underpinning, so that breaches of its provisions are justiciable? That would give the commission enforcement powers that would carry the credibility that we all want. We discussed whether the list was sufficiently comprehensive and flexible under previous amendments, the essence of which was to put parliamentary prioritisation in the minds of all of us who are concerned about the matter. Here, the amendment would give legal earnest to the operation of the commission, using its code. There is differentiation between the words “code” and “guidance” in the two clauses, and if the Minister is going to resist the amendment because he believes that a breach of guidance should be subject to statutory legal proceedings, my point about that difference remains valid. I am not satisfied on the point, and I think that it will be appropriate to press the amendment.

Ben Bradshaw: Was the hon. Gentleman looking for a response, or does he wish to press the amendment come what may? I do not want to detain the Committee.

Stephen O'Brien: It would be helpful if the Minister responded, because I might be able to judge whether to press the amendment further.

Ben Bradshaw: First, the words “code” and “guidance” are equivalent in this case. We are using the word “code” in one instance for consistency and continuity with the existing health care associated infection code of practice. The hon. Gentleman asked why we have changed the wording from “health care acquired” to “health care associated”. It is partly to broaden the definition, because there have been cases, for example, of visitors to hospitals acquiring infections, which is nothing to do with their own health care. The infection is not acquired through their health care but associated with health care in general. I hope that that helps the hon. Gentleman.

Stephen O'Brien: In that case, because we now have it on the record that “code” and “guidance” are indeed the same thing in this case, and that they are not intended to be justiciable either civilly or criminally, I do not need to press the amendment to a Division. The issue is left standing and perhaps needs to be thought through, in the absence of knowing the remit of the regulations that will be the statutory underpinning giving rise to legal proceedings. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 21 ordered to stand part of the Bill.

Clauses 22 to 24 ordered to stand part of the Bill.

Clause 25

Warning notice

Question proposed,That the clause stand part of the Bill.

Stephen O'Brien: On amendment No. 88, it would not be in order to do more than note that it was not selected because it was outside the scope of the clause. However, I hope that the Committee accepts that it would be sensible to flag up our thinking the clause. I believe that we will have the opportunity to debate the matter later, but I want to signpost that warning notices would also be triggered by recommendations arising from complaints. At the moment, we have not seen that, and I hope that we can return to that issue later in the Bill. We thought it relevant to this clause, but we were unable to frame a suitable amendment to force debate, so we will leave it to another time. I hope that that is a useful signpost for the Minister.

Question put and agreed to.

Clause 25 ordered to stand part of the Bill.

Clause 26

Urgent procedure for cancellation

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: There is some discussion to be had on this clause, because it concerns urgent cancellation, which is done on application to a justice of the peace. We will have a longer discussion on the role of justices of the peace when we debate part 3 of the Bill, and my hon. Friend the Member for Guildford will lead for us on that.
I assume that the clause is the legislative framework for the much trailed 24-hour closure of hospitals. The Committee should know that by agreeing to the clause it will be supporting that power. The Department briefed on this on 23 October, before the Bill was published. On 24 October, there was a written ministerial statement, which The Times and The Daily Telegraph both reported. They reported that the Secretary of State was angry that the Healthcare Commission did not step in to try to protect patients or alert the Government to the scale of the problem when it first made its report.
A draft of the Healthcare Commission report into the problems at Maidstone and Tunbridge Wells arrived at the Department on 3 May 2007, but no action was taken by the Department at that point. This is a useful opportunity for the Minister to explain why. The Times further reported:
“The Health Secretary is also expected to reveal in a Commons statement that the new inspectorate will have powers to sack doctors and trust chief executives immediately”.
The Secretary of State already has the power to suspend board members, but the previous Secretary of State did not use that power when she received the Healthcare Commission report in May. Furthermore, there was no mention of the Care Quality Commission having that power in the ministerial statement of 24 October, by which time we had a new Secretary of State. I cannot see a reference to the power in the Bill. No doubt the Minister will point it out to us if I have missed it.
The Committee should also note Anna Walker’s response to the hon. Member for Birmingham, Northfield when she gave evidence to the Committee. She said that the new powers to close wards “are not necessary” and that
“we do not overwhelmingly need them.”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 23, Q 32.]
However, she also said that
“we will use them if they are there.”——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 23, Q 31.]
I am sure that the hon. Gentleman will remember that exchange, and I hope that he will tell the Committee what insight he gained from that line of questioning, which we thought interesting.
In the same sitting, Ian Kennedy said that
“anybody contemplating that you close a major accident and emergency unit...is not in a world that I recognise.”—[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 24, Q 33.]
In his statement to the press on the day of the Committee hearing, he said that
“it would be cavalier to close an element of a major public service without offering patients any alternative.”
Having highlighted those issues, I hope that the Minister will confirm to the Committee whether that is the current arrangement and whether it provides sufficient checks and balances.
With half an eye to the next clause, will the Minister also tell us how the Human Rights Act 1998 would be applied in circumstances in which urgent cancellation might breach aspects of that Act? For example, the cancellation of a nursing care home’s registration might lead to the quick eviction of its residents. One can imagine such a scenario, and it is our job to work out how the rights of patients in such circumstances would interleave with the protection that must be afforded if something has gone sufficiently wrong that a notice withdrawing registration has been received. I appreciate that this point may be a touch legalistic, as I am not sure that if I had a relative in a home that had had its registration removed, I would be very keen for that relative to stay there a minute longer, because I expect that there would be good reason for such a move. However, if the relative were very frail, the speed of eviction might have to be balanced, so the issue of rights would be relevant.
We need to ensure that people’s choices in those circumstances are not limited by the absence of alternatives. There may be practical considerations for people who live in remote areas where there is only one care home for many miles, but equally often people do not have caring relatives or friends who can look out for them when such difficult urgent decisions need to be made.
I hope that the Minister will be able to deal with the question of how the power will help the CQC to deal with superbugs in hospitals, given the remarks made on behalf of the Healthcare Commission in oral evidence. Is the power to be granted on the basis of exigency rather than need? I hope that the Government are not trying to sound tough in the light of recent events. We saw that the Department had briefed The Times to the effect that the CQC will have the power to sack doctors and trust chief executives immediately; but at the moment we struggle to see where that power is set out.

Jeremy Wright: Does my hon. Friend also consider that there may be an issue relating to appeals? If an order for the closure of, for example, the type of residential facility that he has described is made with immediate effect, so that residents are moved out almost immediately, and an appeal is won 28 days later, there may be a difficulty for those who own and run the facility.

Stephen O'Brien: I am grateful to my hon. Friend—I had not thought about that. It is an important point, because the purpose of the 28-day appeal period is to give people an opportunity for fairness and justice; yet such a situation would not arise unless matters were judged to be so serious that most people would say that it was time to get out. It is a matter not only of fairness and justice for the providers or owners of the care setting, but of the rights of, and fairness and justice for, the patients. They are often so frail and vulnerable that the prospect of a move from surroundings that have become familiar—this may be particularly important for people with dementia, who hold on to the physical aspects of their surroundings more than other things—can be sufficiently dislocating to cause their condition to decline. We would all want such effects to be avoided. My hon. Friend’s point is extremely interesting and important, and I expect that the Minister will respond to it.

Ben Bradshaw: I imagine that we shall shortly come to a more general discussion of the powers, so I shall not dwell on that subject now but speak instead directly to the clause, which gives the Care Quality Commission power to apply to a justice of the peace for an order urgently to cancel the registration of a service provider or manager. It sets out the tests that must be met, and requires the commission to notify a number of bodies when it applies for such an order. We all recognise that there may be exceptional occasions when such action may be necessary. The condition for taking such a drastic course of action would be that there was serious risk to a person’s life, health or well-being.
It is important to deal with concerns about notifying the relevant bodies quickly when such an application is made, because, as the hon. Member for Rugby and Kenilworth has pointed out, arrangements will need to be made to look after any patients or clients who may be affected. That is why the provisions require the commission to notify, where appropriate, the relevant local authority, primary care trust or strategic health authority monitor. I do not want to engage in a debate about the powers now, because we shall come on to that in a moment, but I remind Members of the evidence given to the Committee by Dame Denise Platt. She recognised, as we all do, that some of the new powers in the Bill may not, as the hon. Member for Eddisbury said, be appropriate for acute or accident and emergency wards. However, CSCI welcomes the new and broader range of powers because at present it is faced with the stark choice of nothing or closure.
These are permissive powers, but that does not mean that the Care Quality Commission will use them. As Anna Walker indicated, it may not need to use them, although they may be useful as a deterrent and she would not want not to have them. Dame Denise appealed to us not to change the powers or weaken them in any way, because they would be useful in the social care context, and that was what was important to her.

Question put and agreed to.

Clause 26 ordered to stand part of the Bill.

Clause 27 ordered to stand part of the Bill.

Clause 28

Appeals to the Tribunal

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: We had a probing amendment on this clause, which was understandably not selected. It would be helpful if the Minister told the Committee, either now or later, what the form of a tribunal established by section 9 of the Protection of Children Act 1999 is and why it has been chosen, as opposed to other models.

Ben Bradshaw: I cannot do so now, but I will try to do that by the end of the sitting.

Question put and agreed to.

Clause 28 ordered to stand part of the Bill.

Clause 29

Failure to comply with conditions

Stephen O'Brien: I beg to move amendment No. 199, in clause 29, page 15, line 37, leave out from ‘offence’ to end of line 38.

Derek Conway: With this it will be convenient to discuss the following amendments:
No. 200, in clause 29, page 15, line 38, at end insert—
‘(2) A person guilty of an offence under subsection (1) is liable—
(a) on summary conviction, to a fine not exceeding £50,000, or to imprisonment for a term not exceeding 12 months, or to both;
(b) on conviction on indictment, to a fine, or to imprisonment for a term not exceeding 12 months, or both.
(3) In relation to an offence committed before the commencement of section 154(1) of the Criminal Justice Act 2003 (c.44), the reference in subsection (2)(a) to 12 months is to be read as a reference to 6 months.’.
No. 201, in clause 30, page 16, line 13, leave out from ‘liable’ to end of line 14 and add—
‘(a) on summary conviction, to a fine not exceeding £50,000, or to imprisonment for a term not exceeding 12 months, or both;
(b) on conviction on indictment, to a fine, or to imprisonment for a term not exceeding 12 months, or to both.
(5) In relation to an offence committed before the the commencement of section 154(1) of the Criminal Justice Act 2003 (c.44), the reference in subsection (4)(a) to 12 months is to be read as a reference to 6 months.’.
No. 202, in clause 31, page 16, leave out lines 18 to 22 and insert—
‘(2) Subject to subsections (3) to (5), those regulations may not provide for an offence to be triable on indictment or to be punishable with imprisonment or with a fine exceeding level 4 on the standard scale.
(3) Subject to subsection (4), in the case of regulations under section 16, those regulations may provide for an offence to be triable summarily only or either summarily or on indictment and for an offence to be punishable with a fine or imprisonment or both.
(4) In case referred to in subsection (3), those regulations may not provide for an offence to be punishable with—
(a) imprisonment for a term exceeding 12 months, or
(b) in the case of summary conviction, a fine exceeding £50,000.
(5) In relation to summary conviction for an offence committed before the commencement of section 154(1) of the Criminal Justice Act 2003 (c. 44) the reference in subsection (4)(a) to 12 months is to be read as a reference to six months.’.

Stephen O'Brien: The amendments would empower the CQC to seek stronger sanctions against providers who commit offences. Amendments Nos. 201 and 202 would amend clauses 30 and 31 respectively. They arise from Anna Walker’s comments when giving oral evidence. She said that
“at the end of a process like that, there is often considerable public anger and concern about what has gone on and I wonder whether some of the penalty issues need to be recognised in that context. The maximum fine allowed under the new legislation would be £50,000. There is an issue about public concern which that measure does not meet”.——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 25, Q36.]
The point was also made that not only is a wider spectrum of sanctions needed; it will be important to have sanctions suitable for the body in question, given the range of providers that the CQC will register—from small care homes to giant hospitals. The Minister alluded to that point in his response to the last clause stand part debate. There is a world of a difference between what might need to be done in relation to an accident and emergency hospital facility, compared with a small care home.
The amendments would ensure that there is potential for more serious offences to be tried in the Crown court, rather than receiving a maximum fine of £50,000 from magistrates. I therefore ask the Minister, why is the Crown court not available in the pursuit of sanctions? Does he agree with Anna Walker that stronger sanctions need to be available to the CQC? How will these sanctions compare with the current sanctions?

Ben Bradshaw: With your indulgence, Mr. Conway, I will respond briefly to a question that was asked earlier by the hon. Gentleman, to save time and to avoid the danger that I may forget to do so. In fact, he asked two specific questions: first, why this particular tribunal? The Care Standards Tribunal currently hears cases under the Care Standards Act 2000, so we are using that for continuity purposes. Secondly, he asked for the specific figures on outstanding complaints with the Healthcare Commission. In July 2006, the number of open cases was 5,180. In July 2007 it had gone down to 2,298, and I understand that the commission is now meeting its service level agreement targets on complaints. I hope that is helpful to the hon. Gentleman.
On sanctions, I was slightly puzzled by that bit of Anna Walker’s evidence. On the one hand, she seemed to imply that the new enforcement powers were not needed; then, in the quotation given by the hon. Gentleman, there was also an implication that the fines were not heavy enough. I am not clear on the matter, but I hope to discuss it informally with her, which might enable me to reach a better understanding.
The £50,000 figure is a ten-fold increase on the status quo, and it is for a single offence, so there is the potential for multiples of £50,000. It is not that the maximum fine that could be levied against a hospital is £50,000—if there is more than one breach of the regulations, that figure could multiply. As was acknowledged earlier, the Healthcare Commission is not the only organisation that has a locus in monitoring patient safety; there is also the Health and Safety Executive and the criminal law. The hon. Gentleman was right to remind us that criminal investigations are still going on in relation to the Maidstone and Tunbridge Wells incident. That does not mean that hospitals or managers will never be liable for much more serious offences. However, we think that we have come up with a tougher but proportionate suite of penalties and sanctions that suit the role of the Healthcare Commission, that are flexible and that the commission is not forced to use. That should also act as a useful deterrent, because of the damage to reputation that would be incurred by one of those fines or penalties. In light of those assurances, I hope that the hon. Gentleman will withdraw his amendment.

Stephen O'Brien: This is an area in which it is possible to gain a better understanding of the thrust of what Anna Walker at the Healthcare Commission was seeking to achieve, not least in the light of informal discussions that the Minister may have with her. I ask that if those informal discussions result in any proposals, the Minister discuss them with us first, before consideration on Report, so that we can see whether we can find a common view. The sanctions, coupled with the enforcement powers, will be vital to ensuring that we can provide the teeth that we all wish to see bear down on bad practice, and to encouraging best practice. With that proviso, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 29 ordered to stand part of the Bill.

Clause 30

Offences relating to suspension or cancellation of registration

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: I am unclear from the drafting of the clause whether an individual, rather than a corporate person, could be held liable under it. Can the Minister clarify that point?

Ben Bradshaw: Both.

Question put and agreed to.

Clause 30 ordered to stand part of the Bill.

Clauses 31 to 33 ordered to stand part of the Bill.

Clause 34

Provision of copies of registers

Question proposed, That the clause stand part of the Bill.

Stephen O'Brien: In what circumstances might the register not be made public? Which parts of the register might be hidden through regulations under subsection (3)? I note that the memorandum on delegated powers gives the example of a list of children’s homes. As I am sure we are all aware, the regulations here are under negative procedure, but it would be helpful if the Minister clarified what those circumstances are and gave examples, particularly those that might not be made public under subsection (3).

Sandra Gidley: I have couple of general concerns about the clause. Subsection (1) states that copies of registers must be kept
“available at its offices for inspection at all reasonable times by any person”,
and there is a charge if anybody wants any information from the register. However, in these days of the internet, should not the registers, in the greater public interest, be more publicly available, so that people can access the information when they want to? Doing that would remove a level of bureaucracy. Will the Minister give some thought to that?

Ben Bradshaw: I entirely agree. We are leaving it up to the commission to determine how it should make the registers publicly available; it should consider the hon. Lady’s suggestion carefully.
On the question raised by the hon. Member for Eddisbury, we are talking about some particularly sensitive services for children and vulnerable adults that it would not be appropriate publicly to give details about. However, we will set out the circumstances where information should not be provided in the regulations. That will give us a chance to explore the matter in a little more detail.

Question put and agreed to.

Clause 34 ordered to stand part of the Bill.

Clause 35

Bodies required to be notified of certain matters

Stephen O'Brien: I beg to move amendment No. 27, in clause 35, page 17, line 35, at end insert—
‘(aa) to the relevant Local Involvement Network and cooperative group of Local Involvement Networks,’.
In my desperate attempt to ensure that we kill the left-hand column of the selection list by the time we have to close, I should mention that amendment No. 27 would include LINks in the list of bodies to be notified of certain matters. Although that is no doubt possible under subsection (1)(d), it would be useful for it to be included in the Bill. I remind the Committee of the debate on LINks, but I will explicitly mention now CSCI, which in its submission at paragraph 43 stated:
“It would be useful if there were an explicit expectation that the new care provision had a relationship with local involvement networks.”
In the event that the Minister rejects this amendment—I sincerely hope that he will not feel that he needs to or should—I hope that he will add it to his great big box of issues to be reflected on, and come back to the Committee at a later stage with clearer thinking on it.

Greg Mulholland: We have already expressed our concern at the lack of public involvement enshrined in the Bill. Although local involvement networks may or may not be the best way to achieve that, at the moment they are pretty much the only show in town, so we support the intention behind the Bill. I look forward to the Minister’s comments.

Brian Jenkins: The Minister and I are both aware of the fact that circumstances change over time. Although I may have some sympathy with looking at local involvement, I would not want to prescribe which group is to be involved, in case it ceases to exist during the lifetime of the Bill.

Ben Bradshaw: They have only just been born, so give them a chance! As I said, I have sympathy with the motivation behind the amendment. However, I go back to the point that we have made on a number of occasions throughout our deliberations about how prescriptive we are regarding the actions of the new regulator. Although I have stated that LINks will have a valid interest in the work that is done, I fully expect the Care Quality Commission to work closely with LINks—not for exactly the same reasons that Members have been mentioned, but for some of them.
It is not necessarily a good idea to prescribe in the Bill that a particular organisation should be involved in and pre-warned of all the actions that the commission is taking, particularly early on in proceedings before fault or guilt has been found. As I indicated in response to discussion on another clause, there certain issues that may have to be handled sensitively, in respect of which it would not be appropriate to inform LINks or anyone else of the commission’s activities.
Although I sympathise with the spirit of the amendment, the Bill as it stands strikes the right balance between keeping the public and LINks informed, while allowing the commission to carry out its work fairly and appropriately.

Stephen O'Brien: In the light of the Minister’s expressing sympathy but not accepting the amendment, I take that as a “yes” to the matter going into the “I will reflect” box. On that basis, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Derek Conway: I am afraid that we cannot deal with amendment No. 233 because it is 10.25 and I must suspend the sitting.

It being twenty-five minutes past Ten o’clock, The Chairman adjourned the Committee with Question put, pursuant to the Standing Order.

Adjourned till this day at One o’clock.